Comparison of EASI and objective-SCORAD assessments in adult atopic dermatitis.

Atopic dermatitis (AD) is associated with variable severity and extent of lesions. We sought to determine the similarities and differences of objective severity assessments in AD. We performed a prospective study of 388 adolescents and adults (ages 13-93 years) with AD to determine the relationship between the Eczema Area and Severity Index (EASI), Scoring AD (ScorAD) and body surface area (BSA). Overall, EASI and objective-SCORAD were strongly correlated (Spearman correlation, rho=0.92; P<0.0001). However, there was a non-linear relationship between EASI and objective-SCORAD, which was better depicted using a higher order polynomial function. In particular, EASI scores ≤5 were unable to distinguish between fairly broad ranges of objective-ScorAD and BSA. Patients with EASI scores ≤5 had significantly higher objective-ScorAD scores when moderate-severe xerosis was present (Mann-Whitney U test, P<0.0001). Xerosis is scored in objective-ScorAD, but not EASI. Moreover, patients with EASI scores ≤5 had significantly higher objective-ScorAD scores when moderate-severe lesions were localized to the face (P<0.0001), eyelids (P<0.0001), neck (P<0.0001), flexural areas (P=0.004), hands (P<0.0001) and feet (P=0.02). Lesional severity is weighted to the surface area affected in EASI, but not objective-ScorAD. The present study shows a complex relationship between EASI and objective-ScorAD and limited discriminative ability of low EASI scores compared with ScorAD.